Incidence and Surgical Outcomes of Intracranial Arachnoid Cysts: A Systematic Review Comparing Endoscopic Fenestration, Open Craniotomy and Cystoperitoneal Shunt Approaches

Abstract

Background: Arachnoid cysts (ACs) are non-neoplastic collections of cerebrospinal fluid, often posing challenges in diagnosis and management due to their rarity and varied clinical presentations. This systematic review aims to investigate the frequency of ACs, analyse optimal intervention approaches and evaluate neurological complications postoperatively. Materials and Methods: A systematic search of Science Direct, PubMed and Cochrane databases was conducted using controlled vocabulary terms and keywords. Inclusion criteria encompassed studies focusing on adults with symptomatic ACs requiring surgical intervention. Data extraction involved factors influencing subdural haemorrhage, surgical techniques, drainage types and imaging approaches. Adherence to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines ensured methodological rigor and transparency. Results: The review identified multiple surgical approaches, including microsurgical fenestration, endoscopic fenestration and cystoperitoneal shunt, tailored to different cyst locations. Studies showed cystoperitoneal bypass as effective for supratentorial cysts, endoscopic fenestration for midline cysts and cystoperitoneal shunt for infratentorial cysts. Notably, endoscopic fenestration exhibited a 90% success rate, while cystoventricular drainage emerged as an alternative option. However, limitations in comparative studies and variations in follow-up durations hindered comprehensive analyses. Conclusion: Cystocysternostomy, preferably minimally invasive, showed promising outcomes in managing ACs. Wide endoscopic fenestration was recommended without causing damage to adjacent structures. Surgical adaptation for uncontrolled bleeding during procedures was suggested. Intracranial shunts were preferred due to lower infection risks. Postoperative care involving anticonvulsants and conservative antibiotic therapy exhibited low complication rates. Despite limitations in available evidence, this review highlights potential effective interventions for managing ACs, emphasising the need for further comprehensive studies.